Page 156 - 2025 Ranger Medic Handbook

ACETAMINOPHEN (TYLENOL) *
Class: CNS agent – nonnarcotic, analgesic, antipyretic
Action: Analgesia action possibly through peripheral nervous system; fever reduction through direct action on hypo-
thalamus heat-regulating center resulting in peripheral vasodilation, sweating, and dissipation of heat; has minimal
effect on platelet aggregation, bleeding time, and gastric bleeding
Dose: 325–975mg PO q6hr (max: 3g qd)
Onset/Peak/Duration: onset varies/peak 1–3 hours/duration 3–4 hours
Indications: For mild to moderate pain management, headache, fever reduction
Contraindications: Acetaminophen hypersensitivity; use with alcohol
Adverse/Side-effects: Negligible with recommended dose; rash, acute poisoning, anorexia, nausea, vomiting, diz-
ziness, lethargy, diaphoresis, chills, epigastric or abdominal pain, diarrhea, hepatotoxicity: elevation of liver function
tests, hypoglycemia, hepatic coma, acute renal failure; chronic ingestion: neutropenia, pancytopenia, leukopenia,
thrombocytopenic purpura, renal damage
SECTION 4 Interactions: Cholestyramine may decrease absorption; barbiturates, carbamazepine, phenytoin, rifampin, and ex-
cessive alcohol use may increase potential for hepatotoxicity
Mission Impact: None to minimal mission impact
K9 Dosage: DO NOT GIVE

ACETAZOLAMIDE (DIAMOX)
Class: CNS agent – carbonic anhydrase inhibitor; diuretic, anticonvulsant
Action: Diuretic effect due to inhibition of carbonic anhydrase activity in proximal renal tubule, preventing formation of
carbonic acid; anticonvulsant action effect thought to involve inhibition of CNS carbonic anhydrase, retarding abnor-
mal paroxysmal discharge from CNS neurons, decreases production of aqueous humor
Dose: Altitude Illness: PREVENTION: PO 125mg bid; begin the day before the ascent, may discontinue if staying
at same altitude for 2–3 days or if descending. Treatment: PO 250mg bid; Note: With high altitude cerebral edema,
dexamethasone is the primary treatment; however, acetazolamide may be used adjunctively with the same treatment
dose
Indications: For acute high-altitude sickness, seizures, drug-induced edema, and for CHF edema
Contraindications: Sulfonamide and thiazide hypersensitivity; marked renal and hepatic dysfunction; adrenocortical
insufficiency; hyponatremia, hypokalemia, hyperchloremic acidosis; pregnancy category may use during pregnancy
and caution advised while breastfeeding.
Acetazolamide is CONTRAINDICATED in people who are G6PD deficient. All US Active Duty Soldiers are tested
for G6PD deficiency upon accession into the military.
Adverse/Side-effects: Paresthesia, sedation, malaise, disorientation, depression, fatigue, muscle weakness, flaccid
paralysis, anorexia, nausea, vomiting, weight loss, dry mouth, thirst, diarrhea, agranulocytosis, bone marrow depres-
sion, hemolytic anemia, aplastic anemia, leukopenia, pancytopenia, hyperglycemia, hyperuricemia, increased cal-
cium, potassium, magnesium, sodium excretion, gout exacerbation, dysuria, glycosuria, urinary frequency, polyuria,
hematuria, crystalluria, metabolic acidosis, hepatic dysfunction
Interactions: Renal excretion of amphetamines, ephedrine, flecainide, quinidine, procainamide, TCAs may be de-
creased, thereby enhancing or prolonging their effects; renal excretion of lithium and phenobarbital is increased;
amphotericin B and corticosteroids may accelerate potassium loss; increased risk for salicylate and digitalis toxicity
Mission Impact: GROUNDING medication for personnel on flight status
K9 Dosage: Give only if indicated/directed for human use. 250mg q12hr beginning 24 hours prior to ascent OR
500mg q24hr

142 SECTION 4 RANGER MEDIC PHARMACOLOGY & FORMULARY